Can we find the missing men in clinics? Clinic attendance by sex and HIV status in rural South Africa

Abstract

Background: HIV-negative men are over-represented in tuberculosis (TB) prevalence surveys including the first South African national TB prevalence survey in 2018. Traditionally, TB screening is focused in clinics. We aimed to determine the frequency of primary healthcare clinic (PHC) attendance among HIV-negative men in a TB-prevalent setting. Methods: Since January 2017, PHC attendees in a rural South African demographic surveillance area (DSA) were asked their reason for attendance. HIV status was defined as positive if tested positive in a DSA sero-survey or attended clinic for HIV care; negative if tested negative between January 2014—December 2017 and no HIV-related visits; and HIV-unknown otherwise. Results: Among 67124 DSA residents (≥15 years), 27038 (40.3%) were men; 14196 (21.2%) were classified HIV-positive, 18892 (28.1%) HIV-negative and 34036 (50.7%) HIV-unknown. Between April 2017 and March 2018, 24382/67124 (36.3%, 95% confidence interval [CI] 36.0–36.7) adults made ≥1 PHC visit, comprising 9805/40086 (24.5%, 95%CI 23.6–25.3) of HIV-negative or unknown women and 3440/27038 (12.7%, 95%CI 11.6–13.8) of HIV-negative or unknown men. Overall, HIV care accounted for 37556/88109 (42.6%) of adult PHC visits. Conclusion: In this rural population, HIV-negative and -unknown men rarely attend PHCs. Improving TB screening in clinics may not reach a key population with respect to undiagnosed TB. Additional strategies are needed to diagnose and treat TB earlier.

Management of Depression in Chronic Care Patients Using a Task-Sharing Approach in a Real-World Primary Health Care Setting in South Africa: Outcomes of a Cohort Study

“…This sample comprised mostly women, similar to other studies reporting the preponderance of female participants in local PHC settings, attributed to various factors including that women are more likely to be on HIV care while HIV-negative men rarely attend PHC services for any treatment. Regardless of HIV status, antenatal and paediatric care, PHC visits are more frequent among women than men (Randera-Rees et al, 2021 ). HIV and hypertension which are highly prevalent in KwaZulu-Natal were the most prevalent conditions reported, although not necessarily in combination (Conan et al, 2022 ; Pillay, Pillay, & Pillay, 2021 ), and HIV was afforded greater attention by the healthcare system as it was a priority condition.…”

Alcohol use and the pre-exposure prophylaxis continuum of care among men in rural South Africa

“…Whereas men are now included in expanded PrEP access as part of the South African National Strategic Plan for HIV, TB, and STIs, their uptake of PrEP remains alarmingly low [12][13][14][15]. This gendered difference in PrEP uptake mirrors the broader gender disparity in healthcare engagement across Southern Africa [4,[16][17][18]. For example, in Eswatini men were nearly three times less likely to initiate PrEP than women [15].…”